Clinical effects of buttonhole cannulation method on hemodialysis patients

Although the buttonhole cannulation method is now widely used as an alternative to the rope-ladder method in most countries, only the latter method is used in Korea. This study was performed to investigate clinical benefit of the buttonhole technique for arteriovenous fistula (AVF) cannulation in maintenance hemodialysis (HD) patients. Thirty-two patients receiving HD via mature AVF were included and AVF cannulation was performed by 20 experienced nurses. During the 8 weeks, AVFs were cannulated by the rope-ladder method with 15-gauge sharp needles. After creating of 2 pairs of tunnel tracks by sharp needles for 7 weeks, AVFs were cannulated by the buttonhole method using 15-gauge blunt needles during the 16 weeks. Vascular access blood flow rate (BFR), dialysis venous pressure (DVP), and dialysis adequacy (Kt/V) were measured within the first week of the two cannulation methods. Cannulation pain, hemostasis time, and nurse's stress were evaluated at the end of the two methods. There were no statistical differences in vascular access BFR (P = 0.139), DVP (P = 0.152), and dialysis adequacy (P = 0.343) between the two methods. However, the buttonhole method shortened hemostasis time (P = 0.001) and decreased cannulation pain (P = 0.001) as well as nurse's stress (P = 0.001) compared with the rope-ladder method. In conclusion, the buttonhole cannulation method improves hemostasis time, cannulation pain, and nurse's stress without a change in vascular access BFR and dialysis adequacy in HD patients.